Abstract 311: Comparative Effectiveness of Outpatient Cardiovascular Disease Care Delivery Between Physician and Non-Physician Primary Care Providers: Implications for Care Under the Affordable Care Act
Bibliographic record
Abstract
Introduction: With the Affordable Care Act (ACA) implementation, the current number of physicians will not be sufficient to accommodate 30-40 million Americans receiving health care access. A proposed solution is to utilize non-physicians (nurse practitioners, physician assistants) for chronic disease care. Recent studies have shown comparable quality of outpatient cardiovascular disease (CVD) care between physicians and non physicians in cardiology practices. We compared the quality of CVD care between non-physicians and physicians in a primary care setting. Methods: We identified CVD (ischemic heart disease, cerebrovascular or peripheral artery disease) patients with a primary care visit between October 2013 and September 2014 in 130 Veterans Affairs facilities. Using hierarchical regression adjusting for illness-severity and other covariates ( Table ), we compared proportion of patients with BP <140/90 mmHg, LDL-C <100 mg/dL, receiving a statin, receiving moderate to high intensity statin, or receiving a beta-blocker (in those with MI in the last 2 years) among patients receiving care from physicians (n=934,950) and non-physicians(252,085). We also compared the proportion meeting the 3 measures (BP <140/90mmHg, receiving a statin, and receiving a beta-blocker) among eligible patients receiving care from physicians and non-physicians. Results (Table): Although quality of care was numerically comparable; patients receiving care from non-physicians were statistically more likely to have BP control, whereas, patients receiving care from physicians were more likely to have cholesterol control (LDL-C <100 mg/dL, statin or moderate-high intensity statin use), or receive a beta-blocker in adjusted models. Importantly, overall CVD care quality did not differ, with only 54.0% and 54.8% of those receiving care from physicians and non-physicians meeting all 3 eligible measures. Conclusion: Overall CVD care quality delivered by physicians and non-physicians was comparable with modest differences in specific measures. Therefore, a collaborative care delivery model employing physicians and non-physicians may deliver comparable CVD quality to a physician-only model. Regardless of the provider type, there is a need to improve global performance on all eligible measures in CVD patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.054 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".